Provider Demographics
NPI:1659381077
Name:MCBRIDE, MARK T (MD)
Entity Type:Individual
Prefix:DR
First Name:MARK
Middle Name:T
Last Name:MCBRIDE
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:8008 FROST ST STE 106
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92123-4229
Mailing Address - Country:US
Mailing Address - Phone:858-939-5434
Mailing Address - Fax:858-939-5467
Practice Address - Street 1:8008 FROST ST STE 106
Practice Address - Street 2:
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92123-4229
Practice Address - Country:US
Practice Address - Phone:858-939-5434
Practice Address - Fax:858-939-5467
Is Sole Proprietor?:No
Enumeration Date:2006-08-08
Last Update Date:2013-06-25
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAG85544207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00G855440Medicaid
CAH30944Medicare UPIN
CAWG85544AMedicare ID - Type Unspecified